Athletic Career Development in Relation to Health Issues

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ATHLETIC CAREER DEVELOPMENT IN RELATION TO HEALTH ISSUES

Halmstad University

School of Social and Health Sciences Author:

Sport Psychology, 61-90p, autumn 2009 Christoffer Eriksson Supervisor: Prof. Natalia Stambulova

Examiner: Fil. Dr. Urban Johnson

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Eriksson, C. (2009). Athletic career development in relation to health issues. (C-essay in sport psychology 61-90p). School of Social and Health Sciences. Halmstad University.

Abstract

The objectives of this study were to examine: (a) how athletes perceive a relationship between their athletic career and health; (b) how health issues appear across athletic career stages; (c) how athletes perceive health related strategies in regard of the future career goals. The

theoretical frameworks included: the lifespan model on developmental challenge; the circle of health; the developmental model on transitions faced by athletes; the perceived health and sport/exercise participation model. The informants (n=4) consisted of two team athletes and two individual athletes at national or international competitive level. In-depth interviews were carried out based on a semi-structured interview guide specially created for this study. Results are treated and presented as four case studies, and four category profiles describing: the importance of health to the athletic career; the positive influence of athletic career on health;

the negative influence of athletic career on health; health related strategies in the future. The results showed that athletes perceive an obvious and important relationship between the athletic career and health. At the same time a lack of health awareness at early career stages was discovered. It was not until the athletes advanced to a higher competitive level or their health decreased they started to think of health. Athletes also demonstrate low awareness of health in regard to future career goals. The athletes’ experiences were discussed in relation to the theoretical frameworks and previous research.

Key words: Career development, competitive sports, health

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Eriksson, C. (2009). Athletic career development in relation to health issues. (C-uppsats i psykologi inriktning idrott, 61-90hp). Sektionen för Hälsa och Samhälle. Högskolan I Halmstad.

Sammanfattning

Syftena med föreliggande studie var att undersöka: (a) hur idrottare uppfattar ett samband mellan idrottskarriär och hälsa; (b) att undersöka hur hälsofrågor uppträder under en idrottskarriärs olika stadium; (c) att undersöka hur idrottare använder hälsostrategier med tanke på framtida karriärmål. De teoretiska referensramarna inkluderade: the lifespan model on developmental challenge; the circle of health; the developmental model on transitions faced by athletes; upplevd hälsa och idrotts/motionsdeltagande. Försökspersonerna (n=4) bestod av två lagidrottare och två individuella idrottare på nationell eller internationell tävlingsnivå. Djupgående intervjuer genomfördes med hjälp av en semi strukturerad

intervjuguide speciellt tillverkad för denna studie. Resultatet bearbetades och presenterades i form av fyra fallstudier och fyra kategoriprofiler som beskriver: hur viktig hälsan är för idrottskarriären; den positiva inverkan av idrottskarriären på hälsa; den negativa inverkan av idrottskarriären på hälsa; hälsostrategier i framtiden. Resultatet visade på att idrottare

upplever ett tydligt och viktigt samband mellan idrottskarriären och hälsa, men det finns samtidigt en låg hälsomedvetenhet i tidiga karriärstadier. Det är inte förrän idrottare avancerar till en högre tävlingsnivå eller får en sämre hälsa som de börjar tänka på hälsan. Idrottare demonstrerade också en låg hälsomedvetenhet i förhållande till framtida karriärmål.

Idrottarnas upplevelser diskuterades i relation till de teoretiska referensramarna och tidigare forskning.

Nyckelord: Hälsa, karriärutveckling, tävlingsidrott

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Introduction

”The athletic career has affected health a lot, of that I am sure. If you have a fine career, I think you will have a good health . . . and if you turn it around . . . those who maybe did not have the best of health . . . they have not got so far in their career either”.

This statement (expressed by a participant in the present study) reflects upon the importance of career development in relation to health issues. According to the quotation, a successful career involves a good health. A non-successful career involves a somewhat not so good health. An athletic career can mean different things for different people. For some people the athletic career is what they do to make a living. An athletic career is not as long as a working career, and for some it ends sooner than was originally planned. An individual needs to have a good health to be able to achieve what he or she has set out to do. Stambulova (in press) states that: “health is definitely among the most important internal resources for athletes, whereas a lack of health inevitably becomes a barrier to reach sport related goals or meet other career demands”. Health is apparently very important, and there can be a lot of things in the

individual’s life that affects health. In what way health and athletic career influence each other is very interesting to consider. A desirable approach is to investigate how the athletic career affects health as an ongoing event developing through different/several stages.

The purpose of this study is to examine the athletic career development in relation to health issues. The athletic career development and health are seen from a holistic perspective.

To properly understand the theories and models chosen for this paper, a person needs to have an understanding of certain key terms that follows.

Defining key terms

Athletic career development

“Athletic career is a term for a multiyear sport activity, voluntarily chosen by the person and aimed at achieving his or her individual peak in athletic performance in one or several sport events. “Career” relates only to competitive sports, but on all its levels. Depending on the highest level of sport competitions achieved by the athlete, an athletic career can be local, national, or international” (Alfermann & Stambulova, 2007, p.713).

Another athletic career approach is to consider it “as a developmental event contributing to life span development in and out of sport” (Alfermann & Stambulova, 2007, p.713). It also involves facing stages and transitions at different levels of development (Wylleman &

Lavallee, 2004). These stages and transitions will generally occur in an interactive way.

Further, the athletic career development is about “balancing practise, competitions, and recovery; balancing sport and other activities; interpersonal relationships and social interactions; rehabilitation after injuries, etc” (Stambulova, 2009, p.64). The definition by Stambulova (2009, p.64) continues with explaining that “each athlete has a unique genetic make-up, personality characteristics and tendencies, compensation mechanisms, and relationships with his or her environment”.

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Health

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization [WHO], 2006). The definition takes all three areas of physical, psychological, and social well-being into consideration. Biddle and Mutrie (2007) suggest that health is a broad concept, which might include for example a “spiritual” dimension.

People have lots of different views on health (Ewles & Simnett, 2003). How you define health and what aspect you think is important depends on the situation you are in. Therefore the health definition is highly possible to change whenever the situation changes. People’s definition of health is also shaped by knowledge, experience, values, and expectations. To a large population health is seen as “to not be ill”. For some people it also implies building up strength, and having resistance power to avoid infections etc. The clinical health population often have a more objective view on health, and is seeing it as absence of a medically defined disorder or handicap (Ewles & Simnett, 2003).

Turning to theories, there is no existing unified theoretical framework on the athletic career development in relation to health issues. Therefore, the present paper searched for existing theories in the separate fields of career development and health. This search for existing literature in the area led to the findings of the below explained theories and models. They are explained according to the mentioned key terms above.

Theoretical frameworks

Lifespan model of developmental challenge

The lifespan model of developmental challenge by Hendry and Kloep (2002) states that development involves being exposed to, and dealing with large and small challenges from day to day, which will result in learning from it. This response to a challenge will somehow change the individual. If we strive to keep away from challenges there is a risk of limiting our development, and our resources can be drained. The resources are the individual differences, like a resource-“pool” we are born with. These could be either innate, for example reflexes, or they could be learned. Social class and other structural determinants could also create

individual differences. The potential resources can be divided into: biological dispositions (health); social resources (social network); skills in various domains (learning); self-efficacy;

structural resources (gender, class etc.). These resources are not static, and very much interact with each other. The special individual characteristics can be a resource, a disadvantage, or neutral to a person.

There is a dynamic interaction between the potential resources and the potential tasks to be faced, which both can be influenced by situational factors. If the task matches or slightly exceeds the individual’s resources it is perceived as a challenge. If the individual has a feeling of many resources, or feelings of security, it is possible that coping with challenges will be effective. The security feeling will also influence the individual to approach new challenges.

The interaction between resources and task is a key, when facing a new challenge. A

“goodness of fit” situation appears when the resources are matched with the task demands.

Some people can cope with new challenges, but for some it turns out to be a disaster, and his or her life becomes chaotic. The successfully met challenge will add to the individual

resource-“pool”, whereas the unsuccessfully met challenge will drain the “pool”. Out of this, the individual development can increase, stagnate, or decay. It is when the resource-“pool” is

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Though, chasing new challenges is not always a sign of development, because this must be within a state of security. Stagnation is likely to turn into decay if there are too many challenges at the same time or one that cannot be met, due to a lack of resources. A sudden loss of resources can be catastrophic for the individual, when specialization on specific resources is targeted. For example, a competitive skier might break his leg and this can be disastrous for the development if the challenge is met unsuccessfully. The skier might not have the proper resources to cope with the injury. This might stop him or her from getting back to competition.

The circle of health model

Coleen (2003) suggests a metaphorical model (see Figure 1), where she mentions the importance of balance to her definition of health. Balance, harmony, and mind-body integration has been mixed with traditional views on health, e.g. physical, mental, social, well-being etc. The components of the model apply to both body (physical) and mind (mental and spiritual). The model is designed after principles of yin and yang that has a great deal of influence in traditional Chinese medicine, and according to this model, the definition of health is optimal function, well-being, and quality of life.

Figure 1. The Circle of Health model (Coleen, 2003).

The model states that activity and performance, and renewal and recovery should be in balance. They are both equally important to health, and functions as a way of getting optimal function, well-being, and quality of life. Physical, mental, spiritual, social, and role

functioning are objective and subjective factors within the model on each side, which includes the definition of health. The light (right) side of the model represents activity, “giving out”, taking part in activities, and demonstrating the components mentioned in the model. The dark (left) side of the model represents passiveness, “taking in”, relaxing, and demonstrating normal physical functioning (he or she for example sleeps well). Balancing these two sides should give a promising development of your individual health.

Developmental model on transitions faced by athletes

Wylleman and Lavallee (2004) propose a developmental model (see Figure 2) that has a

“beginning-to-end” perspective. It also involves the interactive and developmental nature of transitions at athletic, psychological, social, academic, and vocational level.

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The first layer of the model represents the career stages and normative transitions of the athletic development. The transitions include: transition into organized competitive sports at about age six to seven; transition into an intensive level of training and competitions at about age twelve to thirteen; transition into highest level of training and competition at about age eighteen or nineteen; transition out of competitive sports. The second layer is about normative transitions at a psychological level, and the developmental stages of childhood, adolescence, and adulthood. The third layer of the model is about changes in the social development in relation to the athletic involvement, and what is important to the athlete, concerning family, peers and coach. The fourth layer reflects the academic and vocational levels of the athletic development. Academic involves primary, secondary, and higher education transitions.

Vocational transitions involve the stages from athletic career to professional occupation.

Some of all these transitions may never happen due to different causes.

Figure 2. A developmental model on transitions faced by athletes (Wylleman & Lavallee, 2004). The dotted lines indicate an approximation of the age where the transition occurs.

Perceived health and sport/exercise participation model

The most specific theory relating to athletic career development in relation to health is presented below. Figure 3 presents the modified version of the perceived health and sport/exercise participation model by Stambulova, Johnson, Lindwall and Hinic (2006).

First of all, the model postulates that there are two health related tendencies in sport/exercise participation, which together develop a continuum. One pole of this continuum is healthy sport/exercise participation, and the opposite pole is unhealthy sport/exercise participation.

Each particular athlete or exerciser at the moment can be in any point of this continuum but in total tends to be more to one of the poles, i.e. to healthy or unhealthy sport/exercise

participation.

Second, the model predicts that healthy sport/exercise participation involves perception of health as a goal in sport/exercise (on the basic values/beliefs/attitudes level), using health enhancing strategies helping to accumulate health (on the behavioural level), perception of health as a benefit of sport/exercise participation, high perceived health and satisfaction with sport/exercise participation (on the appraisal level). Alternatively, the model predicts that unhealthy sport/exercise participation involves perception of health as a mean in

sport/exercise (on the basic values/beliefs/attitudes level), a lack of using health enhancing strategies that in fact means draining health (on the behavioural level), perception of health

Age 10 15 20 25 30 35 Athletic

Level Initiation Development Mastery Discontinuation

Psychological

Level Childhood Adolescence Adulthood

Psychosocial Level

Parents Siblings

Peers

Peers Coach Parents

Partner Coach

Family (Coach) Academic

Vocational Level

Primary education

Secondary education

Higher education

Vocational training Professional occupation

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sport/exercise participation (on the appraisal level). Additional factors influencing preference of healthy or unhealthy sport/exercise participation include: an overlap between the images of an athlete/exerciser and a healthy person, goal orientation, physical self-perception profile, self-esteem, and athletic identity (for athletes).

Third, the model emphasizes the importance of micro- and macro- social influences on the athlete/exercisers’ factual preference of healthy or unhealthy sport/exercise participation and also on their possible shifts from one tendency to the other.

Sport/exercise participation (continuum)

Healthy Unhealthy

Health as a goal

Health as a mean

Basic values/

beliefs/

attitudes level

Accumulating health (high in health enhancing

strategies)

Related factors:

-Images of an athlete/exerciser and a healthy person

- goal orientation - athletic identity - physical self- perception profile - self-esteem

Draining health (low in health

enhancing strategies)

Activity/

Behavior level

Perceived health Health as

perceived benefit of

sport/exercise High Low

Health as perceived cost of sport/exercise

Satisfaction with

sport/exercise participation Dissatisfaction with sport/exercise participation

Appraisal level

&

Continuation of healthy sport/exercise

participation

Continuation but with a reversal of

the dominant tendency

Drop out from sport/exercise partcipation

Potential outcomes

Social

macro-

&

micro-

influences

Figure 3. Perceived Health and Sport/Exercise Participation model (Stambulova, Johnson, Lindwall & Hinic, 2006).

Fourth, the model predicts potential outcomes of healthy and unhealthy sport/exercise

participation. Clear dominance of the healthy tendency most probably leads to continuation of sport/exercise participation while a dominance of the unhealthy tendency most probably leads

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to sport/exercise dropout. But any of the dominant tendencies might be reversed, i.e., the athlete/exerciser might make a shift from unhealthy to healthy sport/exercise participation, and also vice versa.

Existing research

Research concerning athletic career development in relation to health issues is a new area where not much has been discovered. However some research that relates to the area of interest has been found.

Athletic career development perspective

Bruner, Erickson, Wilson and Côté (2009) analyzed English literature journals and

highlighted the most frequent used models, definitions, and citations in the existing research field of career development. The results revealed a fraction between a more career- or transition-based emphasis, and a more athletic developmental approach across life-span produced from a stage-based perspective focusing on talent and expertise development. There is also very limited discourse present between these two fractions. The hope is that the field of research will move towards a more systematic and cohesive understanding of athletic

development. Wyllemann, Alfermann and Lavallee (2004) focused their analysis on the European literature on career transitions. They found that transitions are presently viewed in a holistic life-span perspective. This view included athletic and post-athletic career with

transitions also occurring in other domains of athletes’ lives. This is in line with the

developmental model on transitions faced by athletes (Wylleman & Lavallee, 2004), and its

“beginning-to-end” perspective. Early research on career stages contributed with important findings (for a review see Alfermann & Stambulova, 2007). Stambulova (1994) mentioned five athletic career stages: (1) preparatory stage; (2) beginning of specialization; (3) intensive training in chosen sport; (4) culminating stage; (5) final stage, followed by discontinuation.

Côté’s (1999) research revealed four career stages: (1) sampling years; (2) specializing years;

(3) investment years; (4) recreational years.

Durand-Bush and Salmela (2002) interviewed Olympic champions and discovered important contextual factors to the athletes’ development, which consisted of parents, coaches,

teammates/friends, support staff, other athletes, and school/education throughout four stages of their career: sampling; specializing; investment; maintenance years. Gould, Dieffenbach and Moffett (2002) research about psychological characteristics and their development in Olympic champions revealed that the coach, community, family, the individual himself or herself, non-sport personnel, sport environment personnel, and the sport process were important for the individual psychological development. Also adaptive perfectionism, dispositional hope, and high levels of optimism were new important variables to consider.

Stambulova and Alfermann (2009) mention the importance of creating a more sensitive understanding of the context in career research and assistance to athletes. When collecting cross-cultural data it is important to consider cultural specific differences. Athletes need career assistance with cultural specific demands, such as values, beliefs, and traditions that acts as transition barriers.

Career studies focus mainly on career stages and transitions, combining sport and other activities (Stambulova, in press). Health is considered only as a resource in coping with career demands. There is a lack of studies considering careers, especially in elite sports, from a health related perspective (Stambulova, in press).

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Health issues

As a negative aspect of health, stress is often an issue to conduct research on. Scanlan, Stein and Ravizza (1991) found five main sources of stress: negative aspects of competition, negative significant-other relationships, demands or costs of skating, personal struggles, and traumatic experiences. The conclusion they made was that there are individual differences to elite athletes’ sources of stress, and they experience stress from both competition and non- competition. Competition-related stressors were similar among elite and youth athletes.

Similar findings were later presented by Noblet and Gifford (2002), and some of the non- competition stressors were: lack of feedback, difficulty balancing sports and study commitments, and job insecurity. Hanton and Fletcher (2005) addressed important major organizational stressor, which included influences from position insecurity, economics, and advancement and development of the career. Ambiguous selection criteria, perceived

unfairness and inappropriate or prolonged selection process, or late selection are those factors concerning the selection process that can cause stress.

Injury is a very important issue to consider in an athletes’ career. Risk factors to sport related injuries are type of sport, equipment, and individual physical and psychological

characteristics (Johnson, 2007). Johnson (2007) reviewed the existing theoretical approaches and empirical findings, and revealed that different psychosocial factors such as anxiety, emotional state, life changes, coping resources, and social support are directly or indirectly linked to injury outcome. Research on positive health effects of competitive sport

involvement, and conditions for a long-lasting career is in minority (Stambulova, in press).

Alvmyren (2006) study on athletes’ perceived health, goal orientation, athletic identity, self- esteem, physical self perception and sport satisfaction found that social influences on athletes contributed more to unhealthy than to healthy sport participation. The theoretical framework of the study included the perceived health and sport/exercise participation model (Stambulova et al., 2006), and concluded that healthy sport participation contributed to satisfaction with health and sport participation. Unhealthy sport participation contributed to dissatisfaction with health and sport participation.

Looking solely at lifespan research on health, findings shows interesting determinants for health. Research by Vamos and Vamos (2008) mentioned that specific health risks become more critical during certain stages in lifespan (among women). They also addressed that a holistic nature of well-being should involve physical, mental, social intellectual, spiritual, occupational, and environmental dimensions of health. There is a difference in health between individuals, but also between men and women.

Physical, cognitive, social, and personality development are important concepts concerning health and the continuum of growth and development across the lifespan (Leifer & Hartston, 2004).

Relevant definitions, theories, models, and research have been displayed. The summarization of it all enables us to see that there is a lack of knowledge in athletic career development in relation to health issues. Therefore, the objectives of this study are to examine:

(a) how athletes perceive a relationship between their athletic career and health.

(b) how health issues appear across athletic career stages.

(c) how athletes perceive health related strategies in regard of the future career goals.

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Method Participants

The study involved, and was pre-set to, 4 competitive athletes from national to international level. Three males and one female with a mean age of 24 ± 2.3 years old were chosen by convenience sampling. Two of the athletes represented individual sports: golf and long

distance running, and the other two athletes represented team sports: floorball and ice hockey.

The selection criteria for participants in this study were (a) taking part in competitions on a national or international level, (b) being involved in competitive sports for at least 15 years, and (c) being involved in either individual sports or team sports.

Instruments

A semi-structured interview guide “Athletic Career Development in Relation to Health Issues” was created. The instrument in its whole is attached in Appendix 1. The questions in the interview guide were based on, and supposed to reflect, the theories described above. An in-depth interview was of interest and the interview guide consisted of five sections: (1) background information, (2) sport and health, (3) career development, (4) career and health satisfaction, and (5) career future.

In the first section, five questions collect information of the athletes’ background, for example, age, gender, and years involved in competitive sports.

In the second section, three questions collect information of sport and health, where the second question includes a 10-point scale measuring the importance of health to the informants’ athletic career. A high score represents a high importance and a low score

represents no importance. In the third question the informants were asked to state positive and negative influences of their athletic career on health.

In the third section, about career development, the informant was asked to outline the whole athletic career up to present day on a piece of paper, and is asked to mark out stages, name them, and set an approximate age. The informant is also asked to mark out specific important career happenings. Then there are eight specific topics to discuss to each marked out stage, including practice; competition; importance of sport; social support; pressure;

injury/overtraining; health related strategies; perceived health.

In the fourth section, two evaluative questions collect information of athletic career- and health-satisfaction.

In the fifth section, three questions collect information of the informant’s perceived career future, goals, and related health strategies.

Procedure

Initial contact was made by e-mail, which was sent out to sports federations where possible participants could be found. Further contact with interested individuals was then made through e-mail or phone, and they were informed about the interview and the topic of the present study. The interviews were conducted at a place and time, decided by the informants, and tape-recorded on the interviewee’s permission. Prior to the interview, the informants were able to ask questions, and were informed of ethical issues. They were informed of the

voluntary participation, and their right to drop out at any time. The information received from

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Three of the interviews took place in a closed room at a university library, and the fourth took place in a coffee room at the informant’s work place. After the interview the interviewer filled out an after interview debriefing form, reporting about the process of the interview. This was made because of the fact that the interview guide is new and this is valuable information if the guide is going to be used in the future. A summary of four debriefing forms (see Appendix 2) demonstrates that the time and place when conducting the interviews were quite good. The interviews were from 34 to 68 minutes long, and the written interview-texts were between 8 and 13 pages.

Analyses

The qualitative data was analysed from a post-positivist perspective using inductive and deductive analyses in the following steps:

First, the interview full-texts were read thoroughly two or three times and relevant raw data to the particular question were marked, and irrelevant data were deleted.

Second, four case studies were made upon the interview full-texts of the following sections;

Background information; Why they participate in competitive sports; How important health is to the athletic career so far; Positive and negative influence of the athletic career on health;

Career Development (including the 8 topics); How much satisfied they are with the athletic career; How much satisfied they are with their current health; For how long they plan to stay in sports; What they plan to achieve in their athletic career in the future; Health related strategies in the future. A summarization of the four case studies was then done upon each of the mentioned sections above.

Third, the marked raw data of the full-texts was translated into English, and four individual profiles were done (see example in Appendix 3).

Fourth, the raw data of the individual profiles were inductively and deductively analysed. The following four category profiles were derived from the interview guide when creating high- and low-order themes: The importance of health to the athletic career; The positive influence of athletic career on health; The negative influence of athletic career on health; Health related strategies in the future (see Appendix 4).

The quantitative data were treated in SPSS to calculate means, and standard deviations.

Results

The results of this study will be presented in two sections. The first section presents four case profiles according to the parts in the interview guide (all of the names of people or cities etc.

are fictional to ensure the anonymity of the informants). The second section will summarize the cases, and presents the category profiles.

Case 1: A professional floorball player on international level Background information

Peter, a 28-year-old male floorball player. He has been involved in competitive sports for about 20 years of time, competing up to an international level. His main reasons for

participating in competitive sport are that attending competitions and being in a team is fun.

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The importance of health to the athletic career

Peter states his health as completely determinant to his athletic career, and puts it in a bigger perspective where other life aspects should be in balance (i.e. at home or at work).

Positive and negative influence of the athletic career on health

Peter’s positive experiences in his athletic career in regard of his health include being very fit.

He also got exercise as a routine, and will even after termination. It is positive for him that he is surrounded by a lot of people and teammates, he is forced to eat and sleep well, and cannot party. The negative aspects on health is that he sometimes feels that he has to play, even though he suffers from a minor injury or is feeling ill. He has to sacrifice time with his family.

The number of stages reflecting Peter’s athletic career is six, and they include: “Youth/junior teams”; “Senior team”; “Gothenburg”; “6 years”; “France”; “Eskilstuna”.

1. “Youth/junior teams” (8-14 years old, and these are approximate ages)

Peter had practice about three times a week, and he perceived it all as fun. He had two competitions every week. Sport was very important to him because all of his friends were in the same team, and they often played in the streets when there was no practice to attend to.

Peers and parents were very important to him. He did not feel that anybody pressured him to achieve anything. He had a good health and was very seldom ill, but health was nothing he thought of.

2. “Senior team” (14-18 years old)

The number of practise sessions increased to six- to seven times a week, because he was now involved in youth-, junior- and senior team. He did not perceive it as demanding, despite that he also could play up to four games a week. The importance of sport did not change, but his peers became even more important, and his parents were not as involved anymore. Peter felt a slight pressure to achieve, and to be picked out to play in the following game. He won two gold medals in the Swedish national youth- and junior championship during this stage. His involvement in the national youth team made him feel that others expected him to achieve more in his team club than his teammates. His health was continuingly well, but it still was not anything he reflected on.

3. “Gothenburg” (18-20 years old)

Peter transferred to a different team. He now only participated in the first team, and had practice four times a week, and the sessions were from one and a half hours long up to two hours. He played one game a week, and sport was equally important. He spent less time with the new team outside of sport, because he still wanted to hang out with his old friends. His parents now only functioned as an audience, but they still meant much to him. He was a young player that played in the first team, and did not believe that the team had much pressure on him. Mostly he experienced self-pressure to achieve his goals. He started to be more aware of health and why he performed good or bad. Preparations concerning diet and practice crossed his mind. The focus on floorball also became more intense, but he also had other things to think about. He graduated and started to work. He thought that he maybe had a better health at earlier stages.

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4. “6 years” (20-25 years old)

Peter moved 150 kilometres to a different city to play in a new team. Practice and games were of the same amount as before, but were more efficient, and had a better quality. The people he was hanging out with on practise, in the evening, and on weekends, were his teammates. He had no experience of playing in the first division, and did not feel any pressure to achieve, but this increased a lot during this period of six years. He experienced a career highlight when he won the gold medal in the Swedish Floorball Championship. He started to study and therefore became aware of health in a different way. It was necessary to start focus on it, because he could see that those who did not focus on it were affected by it negatively. He thought he had to be thorough about his health, but also acknowledged that his health actually was good.

5. “France” (26-27 years old)

Peter moved to a new country to become a pro- floorball player. The amount of practice and competitions were the same, but he now had other things to focus on. Sport was still number one to him, but he experienced a new country, a new language, new friends, and a lot of other things that had to work out smoothly. He had a partner that meant a lot to him in the process, and it was important to him that they had a good time alongside of sports. Peter experienced the pressure from the club as higher than ever before. The club expected him to win the point table, and to help the team win the gold medal. He experienced a lot of minor injuries during this period. He was unable to play every now and then, and could not achieve his best. His thoughts about to why the injuries appeared concerned the high pressure, and that he should have rested sometimes when he did not. A lot of other things occupied his mind during this period, and he felt scattered. Prior to him moving to be a pro he felt he thought much of health. He knew quite well what was required, and he tried to be prepared. His injuries made health a bit worse, but he experienced a lot of fun things in his spare time that overweighed this.

6. “Eskilstuna” (27-28 years old)

Peter moved back from France to play in his previous team. The amount of practice and competitions were the same, but sport was now less important. Peter and his partner have got a baby, which took a lot of effort. He believes the pressure was the same but he did not care of it as much. He felt good about the fact that floorball was not everything. He relates that

feeling to when he was at the first stages in his career, when it was all about having fun. He focused less on sports and was able to enjoy other aspects of life that he used to neglect. He nowadays feels that he has found a good balance in life.

Career and health satisfaction

Looking back at his career, Peter felt satisfied, but there were some things he might think he should have put more effort into. Peter was very satisfied with his current health, and he felt that he had nothing to complain about. He was very seldom injured, and felt well most of the time. He was in a good situation at home, thought it was fun to work, and it was almost always fun to play floorball. He believed that the athletic career satisfaction and health satisfaction level are somehow connected. The athletic career has affected his health a lot. He states that; “if you have a good career you have a good health”. At the same time he addresses that those who did not have a good health, did not get so far in their career. It is quite clearly connected, according to Peter.

Career future

Peter will continue to compete on high competitive level only until the current season ends, which is in about half a year. He would like to finish with a gold medal in the Swedish

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floorball championship. Peter knows what it takes to accomplish his goals. Ha states that he cannot do more, and it will depend on other things if they win or not. When terminating his elite career, Peter thought that he might notice a big difference. Perhaps there will be more occasions to live unhealthy. He also thought he might be able to do other things for his own enjoyment.

The importance of health to the athletic career: 10

(On a scale from 1 to 10, with 10 being very important and 1, not at all important)

Career satisfaction level: 8

(On a scale from 1 to 10, with 10 being very satisfied and 1, not at all satisfied)

Health satisfaction level: 10

(On a scale from 1 to 10, with 10 being very satisfied and 1, not at all satisfied) Case 2: A national level ice hockey player

Background information

Fredrik, a 23-year-old male ice hockey player. He has been involved in competitive sports for about 19 years of time, and competing up to a national level. His main reasons for

participating in competitive sports is for his own health’s sake, and because it is fun. He also gets to learn how to cooperate, and how to act, as a group.

Health importance to the athletic career

Fredrik thought that health was very important to his athletic career, because everything depends on what you eat, how you sleep, and practice. It is about the way you prepare yourself in the best way to create possibilities to achieve maximum.

Positive and negative influences of the athletic career on health

Fredrik’s positive experience in his athletic career in regard of his health include that he is more or less forced to exercise. This makes him feel better, both physically and

psychologically. The negative experience includes injuries. There is also a chance to get struck by epidemics in team sports.

The number of stages reflecting Fredrik’s career is four, and they include: “Learning”; “Build up”; “Pleasure”; “Advancement”.

1. “Learning” (4-13 years old)

Fredrik had practice about three to six times a week. He played a lot of different sports, and it was all about learning techniques and the basics. It was his choice, and he perceived it all as fun. He liked to play with his friends. He had competitions once a week, and it went quite well. Sport was something really important to focus on for him, because it was fun. He had a lot of support due to the fact that all of his friends were in the same team. His family were a big sports family that supported him. He had no pressure from outside, but as he grew older he started to put pressure on himself. He did not have any health strategies during the stage, because it was all about having fun. He perceived his total health as good.

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2. “Build up” (13-15 years old)

Fredrik started to train physics a bit more. He had practice four to five times a week, plus a little bit extra physics. Competitions were once a week. He thought that everything became more exciting and a little bit more serious, which he perceived as fun. Sport was still number one to him, and he had the same support as before. He thought that his coaches started to put more pressure on him to achieve, and to take an extra step in his development. There were also important Swedish national tournaments he wanted to be selected to. He became more aware of health at this stage, much because his team brought in a specialist on diet and health.

This person talked about what to do, and he came back every year. Fredrik perceived his health as good during this stage.

3. “Pleasure” (15-20 years old)

Fredrik took an important decision to focus not only on ice hockey, but other things in his life as well. His ice hockey team started to practice during summer seriously, up to seven times a week. Fredrik was not prepared to sacrifice all of that time, because he also wanted to play football. So he went from an elite club to an amateur ice hockey club. Now he could play football in the summer and hockey in the winter, only for pleasure. He now gave up on a dream to play in the national team and in the NHL. He had support from his family and coach in this decision. With his new team he had practice five times a week, and he felt he could develop in his own pace without the pressure to achieve. He had one competition a week and made good results. Sport was not as important anymore and he could spend more time with his friends outside of sports. He felt relaxed during this period. Fredrik suffered from a knee injury during this period. A chip from the meniscus got pinched, but he did not have to make surgery. He rested for a month and then began with long walks, and took it step by step. He could not start with summer practice at once with this injury. He did not think of health at this stage, and he perceived his total health as not as good as before. During a summer he grew a lot and did not eat properly.

4. “Advancement” (20-23 years old)

Fredrik made up his mind to go for the top again in ice hockey. He moved to another city, and at the same time he attended try-outs to a division three team. He was successful, and now he put more focus on ice hockey again. He had a total focus on nothing else than practice. He experienced practice as more professional and that there was a thought behind every session.

He practiced seven times a week, and they were a bit shorter than before but more intense.

Competitions were two or three times a week. The outcome of the games was not good, and they had problems with getting the group together. The club had financial problems, and during one season up to sixty percent of the players left the team.

At one time Fredrik also got his first job. Now he had to put an equal amount of focus on both job and ice hockey. His parents supported him and thought it was fun that he advanced in hockey again. They urged him to do his best at work as well. He still had a lot of friends in the team, which he felt a lot of support from. At the same time he felt much higher pressure to achieve from teammates and coaches. No one could fall out of the frame, because then it would get noticed easily. He also had a lot of pressure from himself. Fredrik had two major injuries during this stage. At one time his shoulder joint was dislocated, and it affected his exercising a lot. This happened during an intensive period, and he was out of practice for five weeks. He also missed a lot of games, and had a hard time getting in the team again. A financial disaster struck the club and a lot of players left the team. Fredrik suddenly became a key player. He now had to take a lot of responsibility. The next injury was a skate that hit his knee and cut it open. He had to rest for three weeks. This was during a hold up in the league,

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so he missed no games. Fredrik’s decision to go for ice hockey made him focus on eating properly. He wanted to gain weight. He exercised and ate properly (a lot of carbohydrates and also protein powder) and gained five kilograms. Because of this he had a good health.

Fredrik was satisfied with his sports career so far, but he does not think it is anything special compared to other people. He was happy with the decisions he made during his career.

Fredrik was very satisfied with his current health. He thought that health and athletic career went hand-in-hand. He mentioned an example with if someone have had a tough career and not been comfortable, it can affect your health negatively. Fredrik had experienced his career as successful and fun, and that made him get a good health.

Career future

He wanted to continue with ice hockey until thirty- thirty-five years of age. He still thought of sports as a lot of fun. If no injury puts a stop to his career, Fredrik wanted “to test his wings”.

He and his team had a goal to continue to play in the same division and maybe even advance to the division above. Fredrik himself wanted to develop as much as possible and to step up one level, and maybe even wanted to play in the highest division if possible. To accomplish the goals Fredrik needed to increase the amount of practice even more, for example during the summer. He needed to do fourteen, maybe up to twenty, sessions a week. He also needed to stop drinking coke.

Case 3: An international level golf player Background information

Andreas, a 25-year-old male golf player. He has been involved in competitive sports for about 17 years of time, and competing up to an international level. His main reason to participate in competitive sport is because it is the best thing he knows.

Andreas believed that his health is completely determinant to his athletic career, and it is in late years he feels that way. He wanted to be better and then he needed to take care of himself.

Andreas’ positive experiences in his athletic career in regard of his health include being outside a lot, being in motion. The negative influence on health is sport specific injuries, such as attritional wear on shoulders and elbow.

The number of stages reflecting Andreas career is six, and they include: “Football”; “Table tennis”; “Table tennis advancement”; “Stops playing table tennis”; “Golf advancement”;

“Golf school”.

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1. “Football” (8-10 years old)

Andreas had practice one to two times a week, and he perceived it all as being fun. There was also a lot of spontaneous exercising. He attended competitions once a week, and was quite successful with his team in football. Sport was much important to him, and there was not much else occupying him. His family and coach were supportive, as his friends were, that all played in the same team. Andreas did not have any pressure to achieve from any direction.

During this period he did exercise a lot, but was quite overweight as a child, and perceive his health as moderate to good.

2. “Table tennis” (10-17 years old)

Andreas now played table tennis and had practice two times a week. He experienced it as a little bit tougher and a little bit more disciplined. He had a competition once a week, and did well. Sport was equally important to him. He still hung out with the same friends as in soccer.

Andreas did not have any pressure to achieve from anyone. He perceived his health as better than in the previous stage, but did not do anything special do enhance his health.

3. “Table tennis advancement” (17-20 years old)

Andreas advanced in table tennis. He had practice twice a week but also played in his spare time with a friend. He could practice up to five times a week, and he still had competitions once a week. Andreas was almost always placed in the top. He even won a few, and was ranked top-ten in his region. Sport was still as important, and so were family and friends. He did not perceive pressure from anywhere but himself. He became more aware of health and the importance of eating healthy. But he did not do anything actively about planning his meals before practice. Andreas thinks he had an equally good health as in the previous stage.

Andreas also started to play golf and he won his first golf-tournament.

4. “Stopped playing table tennis” (20-22 years old)

Table tennis became more serious and Andreas lost his motivation. He dropped out of table tennis and started to advance in golf. He played almost every day in summer, and entered about one competition every week. Andreas did well, and he decided to go for golf. Sport was important to him, and the people that meant the most to him were now family, friends, and his girlfriend. He felt a pressure to achieve from his golf club, because they paid a lot of fees for him going into competitions. He knew about health and what to do, but did not do much about it. Still, he perceived his health as good during the stage.

5. “Golf advancement” (22-24 years old)

A period with few changes. Andreas got “full category” on the Nordic Tour, and played very well. He perceived that the pressure on him increased, but only from himself. He felt that the years went by him and he wanted to achieve. Andreas was more active during the winter period, but this was unintentionally. His health was equal to the previous stage.

6. “Golf school” (24-25 years old)

Andreas started to study a sport specific golf-program at a university in Sweden. At the same time he started competing at an international level. His practice sessions increased during the whole year. He felt that the workload was much heavier on him. Andreas had competitions once a week but for a longer period of time during a year. He started to notice result

according to the amount of exercise he has put down effort on. He felt that sport was the most important thing to him, and he was willing to sacrifice a lot to be successful. Andreas got much support from his school and his teachers, which were like coaches to him. He also felt a pressure to achieve from his school, but that was more in terms of them wanting him to do his

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best, not to win competitions. He began to put more pressure on himself because he wanted to achieve since he started at the program. Andreas was injured by an inflammation in one of his shoulders. It did not affect his practice much, because he just had to rest that part of his body.

He worked more actively with his health. He ate better, slept more, and trained physics more often. Andreas perceived his health as better than ever, but not as good as he wanted it to be.

He wanted to optimize himself, to become as good as he could be.

Andreas was satisfied with his career so far. He never played for the national team, and he wishes he had started to go for golf a bit earlier. Andreas was almost completely satisfied with his current health. He was doing everything he could to improve his health, but it was still not where he wanted it to be. This concerned mostly strength and pace. Andreas thought that health and career went hand-in-hand, because whenever he evolved his career he got a better health, and whenever he enhanced his health his career went better.

Career future

He wanted to play golf as long as possible, and he wanted to win a competition in the Nordic League. He also wanted to get out on the European Tour, and optimize everything that has to do with golf: strength, pace, diet, techniques, and everything else. To accomplish these goals, Andreas felt a need to improve both physically and psychologically. He needed to feel well, and to be in a mentally good shape. He also wanted to be stronger and more flexible. Andreas could not mention more specific strategies to do this.

Case 4: A European travelling long distance runner Background information

Linda, a 23-year-old female long distance runner. She moved to Sweden when she was about three years old. She has been involved in competitive sports for about 18 years of time, and competing in the Swedish championship in terrain, and in marathons around Europe. Linda’s main reason to participate in competitive sports is because it motivates her to exercise. She is able to compete against herself, it is fun, and she gets happy after exercising.

Linda thought that health was very important to her athletic career, for the reason that you need to avoid injuries, eat properly, and sleep enough. It also depend on what you believe is health.

Linda’s positive experience in her athletic career in regard of health includes feeling really good and getting outside to relax, because she will “climb the walls” if she do not get to exercise. She is able to enter her own mind, has time to reflect, and to get away from the surrounding world. It helps her with her studies, and she is able to relax better. Linda’s negative experience includes getting injured.

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The number of stages reflecting Linda’s career is four, and they include: “Gymnastics, horse riding, football”; “Alpine skiing”; “Stopped alpine skiing”; “Marathon”.

1. “Mixed sports” (5-13 years old)

Linda was doing gymnastics, horse riding, and soccer, but not at the same time. She practiced one or two times a week, but it were not on a high level. She was not among the best athletes, though sports were not that important to her. Her friends were among the most important to her. Her parents were very positive to her exercising, especially her father, who helped her a lot. She was not aware of health but she was living quite healthy all in all. She was outside a lot, ate a varied diet, and ate candy mostly on weekends. She had pneumonia two or three times, but nothing relating to sports. At the end of this period she moved away from Sweden and from all of her friends. Sport started to be more important to her, because she did not have the social network of people anymore.

2. “Alpine skiing” (13-16 years old)

Sport was the most important thing to her. Linda started alpine skiing every day, and it took up all of her spare time. It was really intense, and she was exhausted when she got home after one day of skiing. At the same time it was a whole lot of fun to her. She felt like she could not miss any practices. She could do up to five or seven weekends with competitions to collect points. Her coaches were important, but most of all her dad was. As a former alpine skier, he was with her on every practice, always being supportive. She felt pressure to achieve from nowhere but herself. Linda had a good health during this stage. She did not think of it or did anything special to get a good health.

3. “Stopped alpine skiing” (16-19 years old)

Linda suffered from a cruciate ligament, but did not know it was that at first. She wanted to continue exercising regularly. She finally realised the seriousness of the injury and she later dropped alpine skiing. This triggered her running, though she could not run to start with. She had to walk on a treadmill, which was really frustrating for her. She later started to seriously practice long distance running. Linda exercised at least six times a week with four strength sessions as well. The competitive season was from May to September. She entered several long distance races with success. She did not have a lot of opponents in her age class, so she won several races. Sport was still really important to her, and she did not want to miss practice. During high school she always had clothes with her, so that she was ready to exercise as often as she could. The medical staff that helped her to recover from the injury was important to her, and her family as well.

Linda and her family moved back to Sweden at the end of this stage when she was seventeen.

Then she was reunited with old friends again. Her friends became important, but sport was still even more important to her. When she was out running, she put pressure on herself. She did not want to stop running. Linda did not have pressure from anyone else. Linda started to think more about her health, especially about what she ate. She controlled her diet very much, and it was not varied. She ate what she believed was healthy, which was not a lot. Compared to how much she exercised, she ate far too little. Linda knew she “took it over the top”. She was also a non-drinker, which was positive to her.

4. “Marathon” (19-23 years old)

Linda trained less strength but ran more mileage a week. She ran three marathons. It took months to prepare, but right around these she had to decrease her practice. Every year she also

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ran about four ten-kilometres races during summer. Sport was equally important as before, but she was also able to skip or move practise if she wanted to hang out with her friends. In 2005 she met her partner, who became really important to her. She was able to spend time with him instead of exercising. He thought her exercising was positive, and he was proud of her. He went in first hand, but she always tried to make an exercise schedule. Linda’s parents were still important to her as well. She was now much better when it came to eating. Her overall health was improved. She was very seldom ill, though she could get a cold or feel very tired. She did not perceive this as negative. She had some minor problems with her foot joints, and her other knee. She got insertions for her shoes to cure this, but at the same time it did not affect her very much.

Linda felt pretty satisfied when she thought back on her career. Especially proud she was when she ran her first marathon. Linda was also satisfied with her current health. She believed that a sports career and health satisfaction relationship exists to a certain part. Her own sports career improvement has been positive, and therefore she thinks that her health was good as well. If a person has a decrease in achievement, it could also result in a depression and making health worse.

Career future

She wanted to continue with running for as long as possible. She wanted to run a lot more marathons, and she could not see an end to it. She did not focus that much on improving her times, but future goals include going below 3.30h on a marathon. She also wanted to go below forty minutes on ten kilometres, but realised that these both goals were hard to

combine. To reach her goals she was going to keep on training. She believed she did not need to change much. She should have put in intervals if she wanted to go below forty on ten kilometres. She needed something extra mentally, as well as a lot of willpower. Though, she was having a hard time motivating herself to do that.

The importance of health to the athletic career: 9,5

Health satisfaction level: 8,5

Cases summary Background information

The cases involved one female and three males, with a mean age of 24 ± 2.3 years old. Two were team sport athletes and two individual sport athletes. Three of the athletes were

competing at an international level, and one at a national level. All four athletes started being involved in competitive sports at a very early stage in their lives. The involvement reached from about a maximum of 20 to a minimum of 17 years. They all participated in competitive sports because of personal enjoyment (i.e. it is fun, and the best of things). The team athletes mentioned the group of people they are in as a reason. One individual athlete and one team athlete mentioned competing as a reason. One athlete mentioned his own health as a goal with participating in competitive sports.

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First, the athletes were asked to value how much important health is to their athletic career on a scale from 1 to 10, with 10 being very important and 1, not at all important. The mean score was of 9.88 ± 0.25, with a maximum of 10 and a minimum of 9,5. They all gave an extremely high score, showing that health is very important to their athletic career. The athletes

explained this with the importance of taking care of oneself, and some of the factors they included were: eating, sleeping, avoiding injuries, and the importance of the social life.

Second, Table 1 (see Appendix 4) presents raw data units, high and low order themes for the category “the importance of health to the athletic career”. In total 14 raw data units were found. The raw data units were classified into four high order themes. The first one is about the importance of “having a fit body”, and covers a total of 43% of the raw data units. Here the athletes mentioned “to nurture/care about your body”, and “to avoid injuries”. The second high order theme states that health is important for “performance improvement”, covers a total of 29% of the raw data units, and described as “to improve performance” and that

“practice brings good health and improved performance”. The third high order theme “overall important” covers a total of 21%, and explains that “everything about health is important”.

The fourth high order theme “social-life aspects” covers a total of 7%. The athletes spoke about the importance of “having a good social life”. One individual athlete and one team athlete were more specific, and talked about food and sleep. The other two thought in a more general sense of this importance of health. The floorball player mentioned a balance in life, such as at home or at work. What they all agreed on was the importance of health as

mentioned above.

The positive influences of the athletic career on health

The athletes were asked to state the positive influences of their athletic career on their health.

Table 2 (see Appendix 4) presents raw data units, high and low order themes for the category

“The positive influences of the athletic career on health”. In total 24 raw data units were found. The raw data units were classified into five high order themes. The first one, “physical nurturing” covers a total of 42% of the raw data units. Here the athletes spoke about

“exercising regularly throughout life”, “body nurturing”, “fit body”, and “physical well- being”. The second one, “psychological nurturing” covers a total of 42% of the raw data units, and the athletes mentioned things concerning “feeling well” and “concentration and thinking”.

The third high order theme “social encounters” covers a total of 8% of the raw data units, the fourth one, “experience nature” cover a total of 4% of the raw data units, and the fifth one,

“overall positive” covers a total of 4% of the raw data units. All four athletes mentioned physical or psychological factors. One of the team athletes mentioned a positive social aspect, which was meeting a lot of other people and teammates.

The negative influences of the athletic career on health

The athletes were asked to state the negative influences of their athletic career on their health.

Table 3 (see Appendix 4) presents raw data, high and low order themes for the category “The negative influences of the athletic career on health”. In total 8 raw data units were found. The raw data units were classified into three high order themes. The first one is about “physical injuries” and covers a total of 66% of the raw data units. The athletes spoke about “acute injuries” and “injuries due to overtraining and/or attritional wear”. The second one, “social- life sacrifices” covers a total of 17% of the raw data units, and is about having to “sacrifice time with important others”. The third one, “epidemics” covers a total of 17% of the raw data units, and is about “spreading diseases” among teammates. What they all agreed on was that physical injuries were a negative factors. The team athletes mentioned social matters, for example spreading diseases and sacrifice time with important others, as negative.

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One individual athlete and one team athlete described their athletic careers as having six stages. The other two athletes divided their careers into only four stages. The most common thing was to name their stages with the current sport they were practicing. The ice hockey player, though, did name his stages by a more subjective experience (i.e. “pleasure” or

“learning”). A summarization of the stages will follow in the discussion.

Career highlights

The athletes were asked to mark out highlights of their athletic career. The most common thing was to mark out happenings connected to wins or when they played well.

First, the athletes were asked how much satisfied they are with their athletic career on a scale from 1 to 10, with 10 being very satisfied and 1, not at all satisfied. The mean score was of 8

± 0.82, with a maximum of 9 and a minimum of 7. All athletes feel satisfied with their career.

Two of them, one individual and one team athlete, also clearly stated what they have done to be very satisfied. This included putting down more effort earlier in their career. The hockey player compared his career with other people, and concluded that his career was ordinary.

Second, the athletes were asked how much they are satisfied with their current health on a scale from 1 to 10, with 10 being very satisfied and 1, not at all satisfied. The mean score was of 8.88 ± 0.85, with a maximum of 10 and a minimum of 8. The floorball player rated his health as 10, and had nothing to complain about. The golf player wanted his health to be better, and did what he could to improve it. The long distance runner and the ice hockey player could not mention anything special to why they were not completely satisfied with their health.

Third, the athletes were asked to wonder about whether they could see a relationship between the career and health satisfaction level. They all agreed on that they somehow are connected.

One individual athlete and one team athlete expressed that this relationship went hand-in- hand. The golf player thought that whenever one of them was increased to a more positive state, the other one followed to be more positive. The long distance runner and the ice hockey player mentioned that a bad career development could result in bad health or even depression.

The floorball player stated that:

“if you have a good career you have a good health”

Career future

The individual athletes could not see an end to their involvement in competitive sports. The team athletes could see an end to their career on the level of competition they were on for the moment. The floorball player only had about half a year left. The ice hockey player would continue until he is thirty- to thirty-five years old. They all had specific goals to achieve in the future. The golf player and the floorball player wanted to win specific tournaments, to win the first price. The long distance runner mentioned specific hours and minutes she wanted to run below on specific long distances. She also was the one who did not have as much motivation as she would like to have to accomplish her goals. The ice hockey player was in a state of mind where he only wanted to develop as much as possible, and to test his wings. The golf player and the ice hockey player were the once who expressed a new beginning, and had the most of things yet to achieve.